This level of automation is also designed to support the broader goals of VBC by fostering greater collaboration between health plans and providers. These systems facilitate data sharing and insights to enable more informed decision-making and a more coordinated approach to patient care. This collaborative model improves the quality of care and strengthens the relationship between health plans and providers, leading to an improved healthcare system.
Intelligent prior authorization represents a major leap forward in the evolution of UM. By mobilizing AI and data-driven insights, these solutions transform UM from a siloed, cumbersome process into a proactive, efficient, and value-driven approach considering the longitudinal care of a condition. In doing so, this technology reduces the prevalence of low-value care, alleviates administrative burdens, and aligns healthcare practices with VBC initiatives.
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By automating the prior authorization process and leveraging data-driven insights, AI dramatically reduces the incentives for low-value care inherent in fee-for-service models. This shift toward VBC ensures patients receive the proper care and treatment plans, improving outcomes and reducing unnecessary costs. The future of UM is marked by intelligent, proactive tools that can streamline administrative tasks for providers and empower health plans to prioritize quality care and patient satisfaction.
About the author: Dr. Traci Granston serves as the Vice President of Clinical Strategy for Musculoskeletal at Cohere Health. Dr. Granston is an orthopedic surgeon based in Washington who specializes in hand surgery and practices at Proliance Orthopedic Surgeons. She attended medical school at Vanderbilt University. She completed her residency in Orthopedic Surgery at Case Western Reserve University School of Medicine and a Hand and Microvascular Fellowship at the University of Washington School of Medicine. Dr. Granston earned her executive M.B.A. from the University of Washington Foster School of Business. She is currently a fellow of AAOS, and also serves on a cabinet at Vanderbilt University School of Medicine dedicated to raising capital for students who may struggle with affording tuition.
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